瑞芬太尼在颅内动脉瘤介入术全静脉复合麻醉中的应用

The Application of Remifentanil in Total Intravenous Anesthesia in Intracranial Aneurysm Intervention

目的：观察异丙酚、瑞芬太尼全静脉麻醉在颅内动脉瘤介入术的临床效应。方法：选择ASA Ⅰ-Ⅱ分级颅内动脉瘤病人28例，随机分为瑞芬太尼组（R组），芬太尼组（F组），记录两组在麻醉诱导及气管插管前后各时段血压、心率、血氧饱和度、呼气末二氧化碳浓度变化；以及术毕病人自主呼吸恢复时间、睁眼时间、拔管时间、拔管时躁动情况和术后并发症。结果：两组患者麻醉诱导后血压、心率较基础值降低（P〈0．01）；F组血压、心率值在插管即刻、插管后5 min较基础值上升但无显著性差异（P〉0．05），R组则下降（P〈0．05）；两组之间存在显著性差异（P〈0．05）；两组麻醉维持阶段循环血流动力学稳定，PETCO2均维持在30～40mmHg之间；术后自主呼吸恢复时间，睁眼时间，拔管时间，R组明显短于F组（P〈0．05）。结论：微量泵注异丙酚和瑞芬太尼全静脉麻醉诱导平稳，血流动力学稳定，苏醒质量优良，术后恶心呕吐发生率低。

Objective To investigate the effects of remifentanil in total intravenous anesthesia in intracranial aneurysm intervention. MethodSTwenty -eight ASA Ⅰ-Ⅱ patients undergoing intracranial aneurysm intervention were randomly divided into two groups：R （Remifentanil group） and F （Fentanyl group）. The change of blood pressure,heart rate,oxygen saturation of functional hemoglobin （SPO2 ） ,end expiration CO2 were observed;and the time of spontaneously breathing ,eyes opening and restlessness at extubation, and postoperative complications at anesthesia induction and tracheal extubation was also recorded. Results There was a significant decrease of BP and HR after anesthesia induction of the two groups. There was no significant difference at tracheal intubation immediately after anesthesia induction and 5mins after tracheal intubation in F group（ P 〉0.05） ,but it was opposite in group R（ P 〈 0.05）. Hemodynamics and PETCO2 （ sustaining 30 - 40 mmHg ） were stably maitained in both F group and R group. The time of spontaneously breathing recovery, eyes opening, extubation was obviously shorter in R group than that in F group （P 〈 0.05 ）. Conclusions Propofol and remifentanil with total intravenous anesthesia are more stable during anesthesia induction with micro pump injection,its hemodynamics is more steady, palinesthesia is better and the incidence of nausea and vomitting is lower.